Authors: Mei-Hwei Chang and San-Lin You and Chien-Jen Chen and Chun-Jen Liu and Ming-Wei Lai and Tzee-Chung Wu and Shu-Fen Wu and Chuan-Mo Lee and Sheng-Shun Yang and Heng-Cheng Chu and Tsang-Eng Wang and Bor-Wen Chen and Wan-Long Chuang and Maw-Soan Soon and Ching-Yih Lin and Shu-Ti Chiou and Hsu-Sung Kuo and Ding-Shinn Chen and Yao-Jong Yang and Gin-Ho Lo and Man-San Kong and Po-Ming Wang and Chi-Chieh Yang and Chia-Hsiang Chu and Lung-Huan Lin and Rong-Nan Chien and Tzong-Hsi Lee and Kuo-Ching Yang and Li-Ying Liao and Lein-Ray Mo and Jean-Dean Liu and Tzeng-Huey Yang and Ching-Chu Lo and Ming-Hung Tsai and Chang-Hua Chou and Yeong-Shan Cheng

Journal: Gastroenterology

Year: 2016

Abstract:

Background & Aims The incidence of hepatocellular carcinoma (HCC) increases with age, but protective antibody responses decrease with time after infants are immunized against hepatitis B virus (HBV). We investigated whether immunization of infants against {HBV} prevents their developing {HCC} as adults. We also searched for strategies to maximize the cancer-preventive effects. Methods We collected data from 2 Taiwan {HCC} registry systems on 1509 patients (6–۲۶ years old) diagnosed with {HCC} from 1983 through 2011. Data on history of {HBV} immunization and prenatal maternal levels of {HBV} antigens of all {HCC} patients born after July 1984 were retrieved from the {HBV} immunization data bank of the Taiwan Center for Disease Control. We collected data on birth cohort-specific populations (6–۲۶ years old) of Taiwan using the National Household Registry System. Rates of {HCC} incidence per 105 person-years were derived by dividing the number of patients with {HCC} by the person-years of the general population. Relative risks (RR) for {HCC} were estimated by Poisson regression analysis in vaccinated vs unvaccinated birth cohorts. We stratified patients by age group to evaluate the association of birth cohorts and {HCC} risks. Results Of the 1509 patients with HCC, 1343 were born before, and 166 were born after, the {HBV} vaccination program began. {HCC} incidence per 105 person-years was 0.92 in the unvaccinated cohort and 0.23 in the vaccinated birth cohorts. The {RRs} for {HCC} in patients 6–۹ years old, 10–۱۴ years old, 15–۱۹ years old, and 20–۲۶ years old who were vaccinated vs unvaccinated were 0.26 (95% confidence interval [CI], 0.17–۰٫۴۰), ۰٫۳۴ (۹۵% CI, 0.25–۰٫۴۸), ۰٫۳۷ (۹۵% CI, 0.25–۰٫۵۱), and 0.42 (95% CI, 0.32–۰٫۵۶), respectively. The {RR} for {HCC} in 6- to 26-year-olds was lower in the later vs the earlier cohorts (born in 1992–۲۰۰۵ vs 1986–۱۹۹۲; P < .001 and 1986–۱۹۹۲ vs 1984–۱۹۸۶; P < .۰۰۲). Transmission of {HBV} from highly infectious mothers and incomplete immunization were associated with development of HCC. Conclusions Based on an analysis of 1509 patients with {HCC} in Taiwan, immunization of infants against {HBV} reduces their risk of developing {HCC} as children and young adults. Improving {HBV} vaccination strategies and overcoming risk factors could reduce the incidence of liver cancer.

نویسندگان: Mei-Hwei Chang and San-Lin You and Chien-Jen Chen and Chun-Jen Liu and Ming-Wei Lai and Tzee-Chung Wu and Shu-Fen Wu and Chuan-Mo Lee and Sheng-Shun Yang and Heng-Cheng Chu and Tsang-Eng Wang and Bor-Wen Chen and Wan-Long Chuang and Maw-Soan Soon and Ching-Yih Lin and Shu-Ti Chiou and Hsu-Sung Kuo and Ding-Shinn Chen and Yao-Jong Yang and Gin-Ho Lo and Man-San Kong and Po-Ming Wang and Chi-Chieh Yang and Chia-Hsiang Chu and Lung-Huan Lin and Rong-Nan Chien and Tzong-Hsi Lee and Kuo-Ching Yang and Li-Ying Liao and Lein-Ray Mo and Jean-Dean Liu and Tzeng-Huey Yang and Ching-Chu Lo and Ming-Hung Tsai and Chang-Hua Chou and Yeong-Shan Cheng